The trial of sending short message service multidrug-resistant tuberculosis patients in Indonesia

The chance to increase knowledge and motivation


  • Syarifah Syarifah Universitas Sumatra Utara
  • Devi Nuraini Santi Universitas Sumatera Utara



MDR-TB, sms delivery, knowledge, motivation, indonesia


Background. MDR TB (multidrug-resistant tuberculosis) is a threat for the future control of TB disease. In Indonesia, the success rate of MDR TB patient recovery is still very low, following the still low recovery rate of TB patients.

Objective. This paper aims to discuss the trial result of message delivery containing knowledge and motivation to the MDR TB sufferers.

Methods. There are about 34 MDR TB patients participating in this research. During the research, everyone received a message in their handphone or the handphone of their family members every day, contained information on medication and motivation to comply with the medication. At the end of the research, the measurement on knowledge and attitude, on the compliance with medication, and on the compliance with laboratory examinations was conducted.

Results. The results were compared with the assessment before this intervention was conducted. Out of 32 patients that managed to complete the intervention, the average means of their knowledge and attitude increased significantly. The average mean of knowledge before the intervention was 9.74 to become 10.94, and the average mean of attitude was from 7.06 to become 18.47 (p<0.05). Meanwhile, the medication compliance score and the laboratory examination compliance score also changed significantly (p<0.05). SMS delivery routinely even in a short period of time managed to change knowledge and motivation of MDR TB sufferers.

Conclusions. To conclude, it is necessary to develop recent technology effort in order to scalling-up MDR TB patients. Existing social channels in the community must be used intensivelly to reduce this disease negative impact.

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WHO. Tuberculosis. 14 October. Published 2021. Accessed May 24, 2022.

Cohen A, Mathiasen VD, Schön T, Wejse C. The global prevalence of latent tuberculosis: A systematic review and meta-analysis. European Respiratory Journal. 2019;54(3):1-14. doi:10.1183/13993003.00655-2019 DOI:

WHO. Global Tuberculosis Report 2021. WHO; 2021.

WHO-SEARO. Indonesia commitment to eliminate TB by 2030 supported by the highest-level government. 28 November 2021. Published 2021. Accessed April 6, 2022.

Ministry of Health. Strategi Nasional Penanggulangan Tuberkulosis Di Indonesia 2020-2024. Ministry of Health; 2020.

Ministry of Health. Manajemen terpadu pengendalian TB Resisten Obat (MTPTRO). Published 2021. Accessed April 6, 2022.

WHO. Digital Health for the End Tb Strategy: an Agenda for Action. Who. Published online 2015:24.

WHO. World Health Organization. Resolution WHA 71.7: Digital Health.; 2018.

Alipanah N, Jarlsberg L, Miller C, et al. Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies. PLoS medicine. 2018;15(7):e1002595. doi:10.1371/journal.pmed.1002595 DOI:

Lee Y, Raviglione MC, Flahault A. Use of Digital Technology to Enhance Tuberculosis Control: Scoping Review. Journal of medical Internet research. 2020;22(2):e15727. doi:10.2196/15727 DOI:

Mwansa-Kambafwile JRM, Chasela C, Levin J, Ismail N, Menezes C. Treatment initiation among tuberculosis patients: the role of short message service (SMS) technology and Ward-based outreach teams (WBOTs). BMC public health. 2022;22(1):318. doi:10.1186/s12889-022-12736-6 DOI:

Babirye D, Shete PB, Farr K, et al. Feasibility of a short message service (SMS) intervention to deliver tuberculosis testing results in peri-urban and rural Uganda. Journal of clinical tuberculosis and other mycobacterial diseases. 2019;16:100110. doi:10.1016/j.jctube.2019.100110 DOI:

Tetra Dewi FS, Sudiya S, Supriyati S, et al. Preparing Short Message Service Reminders to Improve Treatment Adherence among Tuberculosis Patients in Sleman District, Indonesia. Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine. 2019;44(2):81-87. doi:10.4103/ijcm.IJCM_207_18

USAID Indonesia. Strenghtening Private Provider Engagement to Improve TB Outcomes in Indonesia, An Institutional Review.; 2018.

Ridho A, Alfian SD, van Boven JFM, et al. Digital Health Technologies to Improve Medication Adherence and Treatment Outcomes in Patients With Tuberculosis: Systematic Review of Randomized Controlled Trials. Journal of medical Internet research. 2022;24(2):e33062. doi:10.2196/33062 DOI:

Kusheno FT, Nguse TM, Gebretekle GB. Assessment of Knowledge and Attitude of Tuberculosis Patients in Direct Observation Therapy Program towards Multidrug-Resistant Tuberculosis in Addis Ababa, Ethiopia: A Cross-Sectional Study. Tuberculosis research and treatment. 2020;2020:6475286. doi:10.1155/2020/6475286 DOI:

Maharaj J, Ross A, Maharaj NR, Campbell L. Multidrug-resistant tuberculosis in KwaZulu-Natal, South Africa: An overview of patients’ reported knowledge and attitudes. African journal of primary health care & family medicine. 2016;8(1):e1-6. doi:10.4102/phcfm.v8i1.1089 DOI:

Mpagama SG, Ezekiel MJ, Mbelele PM, et al. Gridlock from diagnosis to treatment of multidrug resistant tuberculosis (MDR-TB) in Tanzania: patients’ perspectives from a focus group discussion. BMC public health. 2020;20(1):1667. doi:10.1186/s12889-020-09774-3 DOI:

Rajendran M, Zaki RA, Aghamohammadi N. Contributing risk factors towards the prevalence of multidrug-resistant tuberculosis in Malaysia: A systematic review. Tuberculosis (Edinburgh, Scotland). 2020;122:101925. doi:10.1016/ DOI:

De Schacht C, Mutaquiha C, Faria F, et al. Barriers to access and adherence to tuberculosis services, as perceived by patients: A qualitative study in Mozambique. PloS one. 2019;14(7):e0219470. doi:10.1371/journal.pone.0219470 DOI:

Das M, Mathur T, Ravi S, et al. Challenging drug-resistant TB treatment journey for children, adolescents and their care-givers: A qualitative study. PloS one. 2021;16(3):e0248408. doi:10.1371/journal.pone.0248408 DOI:

Loveday M, Sunkari B, Master I, et al. Household context and psychosocial impact of childhood multidrug-resistant tuberculosis in KwaZulu-Natal, South Africa. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 2018;22(1):40-46. doi:10.5588/ijtld.17.0371 DOI:

Zhang P, Xu G, Song Y, Tan J, Chen T, Deng G. Challenges Faced by Multidrug-Resistant Tuberculosis Patients in Three Financially Affluent Chinese Cities. Risk management and healthcare policy. 2020;13:2387-2394. doi:10.2147/RMHP.S275400 DOI:

Poce G, Biava M. Overcoming drug resistance for tuberculosis. Future microbiology. 2015;10(11):1735-1741. doi:10.2217/fmb.15.76 DOI:

Xing W, Zhang R, Jiang W, et al. Adherence to Multidrug Resistant Tuberculosis Treatment and Case Management in Chongqing, China - A Mixed Method Research Study. Infection and drug resistance. 2021;14:999-1012. doi:10.2147/IDR.S293583 DOI:

Li H, Zhang H, Xiong J, et al. Factors Associated with Medical Follow-Up Adherence for Patients on All-Oral Regimen for Multidrug-Resistant Tuberculosis in Shenzhen, China. Patient preference and adherence. 2021;15:1491-1496. doi:10.2147/PPA.S316253 DOI:

Wagstaff A, van Doorslaer E, Burger R. SMS nudges as a tool to reduce tuberculosis treatment delay and pretreatment loss to follow-up. A randomized controlled trial. PloS one. 2019;14(6):e0218527. doi:10.1371/journal.pone.0218527 DOI:

Lester R, Park JJ, Bolten LM, et al. Mobile phone short message service for adherence support and care of patients with tuberculosis infection: Evidence and opportunity. Journal of clinical tuberculosis and other mycobacterial diseases. 2019;16:100108. doi:10.1016/j.jctube.2019.100108 DOI:

Ali AOA, Prins MH. Mobile health to improve adherence to tuberculosis treatment in Khartoum state, Sudan. Journal of public health in Africa. 2019;10(2):1101. doi:10.4081/jphia.2019.1101 DOI:

Hirsch-Moverman Y, Daftary A, Yuengling KA, et al. Using mHealth for HIV/TB Treatment Support in Lesotho: Enhancing Patient-Provider Communication in the START Study. Journal of acquired immune deficiency syndromes (1999). 2017;74 Suppl 1(Suppl 1):S37-S43. doi:10.1097/QAI.0000000000001202 DOI:

Musiimenta A, Tumuhimbise W, Atukunda EC, et al. Mobile Health Technologies May Be Acceptable Tools for Providing Social Support to Tuberculosis Patients in Rural Uganda: A Parallel Mixed-Method Study. Tuberculosis research and treatment. 2020;2020:7401045. doi:10.1155/2020/7401045 DOI:

Musiimenta A, Tumuhimbise W, Mugaba AT, et al. Digital monitoring technologies could enhance tuberculosis medication adherence in Uganda: Mixed methods study. Journal of clinical tuberculosis and other mycobacterial diseases. 2019;17:100119. doi:10.1016/j.jctube.2019.100119 DOI:

Subbaraman R, de Mondesert L, Musiimenta A, et al. Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities. BMJ global health. 2018;3(5):e001018. doi:10.1136/bmjgh-2018-001018 DOI:

Zaluchu F. Engaging the local church to tackle stunting in Indonesia : a case study in Nias Island. Christian Journal for Global Health. 2022;9(2). DOI:



How to Cite

Syarifah, S., & Santi, D. N. (2023). The trial of sending short message service multidrug-resistant tuberculosis patients in Indonesia : The chance to increase knowledge and motivation. Journal of Public Health in Africa, 14(12).



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